The Mission Report, 2003:
Priorities for Mental Health Sector Development in Gujarat

In April 2002, the Department of Health and Family Welfare, Government of Gujarat, constituted a Mission with the objective of suggesting priority strategies for mental health sector development. This work was to guide a policy document that the Government of Gujarat was preparing. The Indian Institute of Management, Ahmedabad (IIMA), in collaboration with B.J. Medical College, Ahmedabad, and Bapu Trust, Pune, carried out the Mission activities for which the Royal Netherlands Embassy Development Co-operation Division, New Delhi, provided financial support.

The Mission Team

• Prof. Ramesh Bhat, IIMA (Mission Coordinator)
• Dr. Bhargavi Davar, Bapu Trust
• Dr. G.K. Vankar, BJ Medical College
• Prof. Sunil Maheshwari, IIMA
• Prof. Amita Dhanda, University of law, NALSAR, Hyderabad
• Dr. Vikram Patel, Senior Lecturer, London School of Hygiene & Tropical Medicine and Chairperson, Sangath Society, Goa
• Prof. Piyush Sinha, IIMA
• Dr. Ritambhara Mehta, Surat Medical College, Surat
• Dr. Sohan Derasari, Practising psychiatrist

The Mission work was peer-reviewed by the following panel that also took part in the Core Group discussions:

Dr. R.H. Bakre, Programme Officer, Mental Health Programme, Department of Health & Family Welfare, Government of Gujarat
Dr. Kiran Rao, Additional Professor of Clinical Psychology, NIMHANS, Bangalore
Mr. Jos Brand, Institutional Development Consultant

The Mission team prepared the background papers for the Mission Report. These background papers were prepared using extensive local research, situational studies, reviews of local literature, workshops and consultations with a wide spectrum of stakeholders. The background papers are available from the Mission co-ordinator for the purpose of reference. Ramesh Bhat, Bhargavi Davar and Sunil Maheshwari prepared the draft chapters of the Mission Report based on the background papers.

A copy of the report may be obtained from the Department of Health and Family Welfare, Gujarat, or from the Mission Co-ordinator, Indian Institute of Management, Ahmedabad, Vastrapur, Ahmedabad.

At Bapu, we have enjoyed working on this report and it gave us immense experience and learning about policy building and policy influencing.

An Overview of the Mission Report
It is estimated that there are 2.8 million adults with common and severe mental health problems at any given point in Gujarat. Every year, around 11,000 new cases of schizophrenia are added to the mental disorder burden. Despite the enormity of the problem, less than one per cent of the total health budget is spent on mental health. Besides, the funds are spent on hospital and institutional services, which cater especially to severe mental illnesses and on salaries for the staff. Very little, therefore, is available for the other components of the mental health programme.

The mental health sector faces a number of additional challenges: a shortage of trained mental health professionals, inadequate training capacity, lacunae in laws and regulation, absence of multidisciplinary approach, poor to non-existent linkages between community and hospital based care, and weak institutional framework. The Mission Report discusses them in detail, taking also into account the other challenges facing the sector. It provides a number of suggestions on what should be the strategic responses to these challenges.

The Gujarat Government is planning to formulate shortly a policy on mental health and the recommendations in this Report may form the basis of this policy. The Terms of Reference given for policy recommendations to the Mission were as follows:

Ensure availability and accessibility of minimum mentalhealth care for all in the near future
Encourage the application of mental health knowledge in general health care and in social development
Promote community participation in mental health service and stimulate efforts towards self-help in the community.

Other conditions necessary for efficient policy implementation were also considered, including: A suitable structure for financing, organisation and management of the improvement strategies; Adequately skilled and motivated human resources.